Patient Files

CAHPS Home Health Care Survey (CMS-10275)

Documents and Forms

Document Name Document Type
Attachment D_ P and G Manual-Chapter4_Sampling_12_29_2022.pdf Instruction
Attachment D_ P and G Manual-Chapter4_Sampling_12_29_2022.pdf Instruction

Information Collection (IC) Details

IC Title:	Patient Files	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 484.250

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment D_ P and G Manual-Chapter4_Sampling_12_29_2022.pdf		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,819	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	105,828	-2,052	107,880
Annual IC Time Burden (Hours)	211,656	-4,104	215,760
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.